Today marks the 40th anniversary of Roe v Wade. Shockingly, in the 40 years since the Supreme Court's landmark ruling legalising a woman's right to a safe, legal abortion in the United States, abortion laws have gone in a circle, progressing from illegal before Roe v Wade to legal to progressively more restrictive laws being enacted in many states.

In some states, abortion is now not an option unless the woman travels out of state because threats and legal penalties against doctors who perform abortions have made the business of providing safe, legal abortions to women unsafe for medical practitioners and their support staff. I never imagined that 18 years after The Abortion Dilemma was published the issue would still be so politically divisive in the United States or that Roe v Wade would be threatened with reversal.

Worldwide, according to the World Health Organisation, the abortion rate has dropped from 50-60 million a year to an estimated 46 million a year, a figure that includes 20 million illegal abortions. This is largely attributed to easier access to contraception and greater access to safe, legal abortion and medical care.

While the death rate has dropped from an estimated 250,000 annually to about 67,000 a year, millions more women are still injured, often permanently, as a result of unsafe abortion. The main causes of death from unsafe abortions are haemorrhage, infection and poisoning from substances used to induce abortion in areas where women cannot gain access to safe medical treatment.

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Other complications include sepsis and peritonitis as well as trauma to the cervix, vagina, uterus and abdominal organs. Infection can lead to infertility and other long-term risk factors such as ectopic pregnancies and miscarriage. Tetanus threatens women who have not been immunised who have an unsafe abortion and gas gangrene from Clostridium perfringens commonly results from insertion of foreign bodies.

By startling contrast, manual vacuum aspiration and medical methods of inducing abortion using medications have reduced complications for safe, legal abortion and the death rate has dropped to fewer than one in 100,000.

WHO's statistics are underscored by its sad conclusion that the underlying cause of the ongoing global pandemic of death by unsafe abortion is apathy and disdain for women, who suffer and die because they are not valued. Being pro-legal abortion is without question being pro-life for pregnant women. Being anti-legal abortion doesn't save pregnancies - it simply kills pregnant women.

That is why internationally, abortion is a human rights and public health issue. When a woman dies as a result of an unsafe abortion, her death can have a significant impact on her family, especially her other children. WHO estimates that 220,000 children lose their mother every year because of complications from unsafe abortion. There are also financial and socio-economic consequences for the family.

While many countries have moved to make abortion legal with no restrictions in the first 12 weeks, several countries have passed laws making it more difficult to obtain a safe, legal abortion, most notably Poland, El Salvador and the US.

Notably, countries that liberalised their abortion laws such as Barbados, Canada, South Africa, Tunisia and Turkey did not experience an increase in abortion. The Netherlands, which has unrestricted access to free abortion and contraception has one of the lowest rates of abortion in the world.

Criminalising abortion doesn't stop or lower the rate of abortion - it simply leads to more women dying needlessly. We must all fight for safe, legal abortion if we truly value women.

During the infamous Healthcare Reform negotiations in the US, abortion repeatedly held the dream of universal healthcare hostage, ultimately leading to compromises ostensibly to satisfy the consciences of anti-abortion lawmakers but ultimately enhancing their state coffers. Abortion equals leverage in American politics and leverage buys dollars.

Since I do not want to lend credence to or legitimise the outrageously ignorant anti-abortion/anti-women views expressed by several Tea Party Republican candidates during the 2012 presidential election, I have purposely omitted discussion of those views. Such candidates don't merit mention except as a footnote testifying to the wisdom of Americans who voted to throw them out of office.

I do not believe that Americans are more moral than the rest of mankind. What I have realised is that Americans are more vulnerable to an oft-repeated sales pitch, however wrong the author might be on the subject. Pithy sound bites sell, as does repetition - if you repeat something often enough, even a lie, people believe it.

The First Amendment guaranteeing free speech is the ultimate enabler of intolerance and terrorism if people are allowed to incite others to murder in the name of a supposed good. I do not believe free speech gives us the right to exhort others to kill doctors who perform an abortion or politicians who support legal abortion. Such terrorist threats must be taken seriously by lawmakers and banned.

If you don't believe in abortion, then don't have one, but do not deny other women the right to have a safe abortion if that is what they choose. The lives of women must be valued above and protected from religious and cultural mores that deem the unborn foetus of greater value than the pregnant woman.

When I began writing The Abortion Dilemma: Personal Views on a Public Issue, I meant it to be an apolitical, self-help book for women (and their partners) confronted by an unintended pregnancy and abortion decision. On a personal level, abortion is apolitical but on a public level, like it or not, it is a political issue. There is an inherent conflict between the public and private perception of abortion.

Publicly, politically and morally, reason must prevail.

Miriam Claire is author of The Abortion Dilemma: Personal Views on a Public Issue, first published in 1995. This is an extract from the updated version of her book out this month.

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